Ruminations by a non-academic general surgeon from the heart of the rust belt.

Monday, July 6, 2009

Profoundly Ignorant

Former Treasury Secretary Paul O'Neill (no, not the unlikable retired New York Yankee outfielder, although both have about the same credibility when it comes to health care reform opinions) has a curious op-ed in the NY Times today. According to Mr. O'Neill, we don't need more entitlements to fund health care reform. The financing solution is simple; just make those damned doctors eliminate all hospital related infections and errors, the bastards!

The president says he likes audacious goals. Here is one: ask medical providers to eliminate all hospital-acquired infections within two years. This is hardly pie in the sky: doctors and administrators already know how to do it. It requires scrupulous adherence to simple but profoundly important practices like hand-washing, proper preparation of surgical sites and assiduous care and maintenance of central lines and urinary catheters. With these small steps, we would no longer have the suffering and death associated with infections acquired in hospitals and we would save tens of billions of dollars every year — money we should have in hand before new health-care entitlements are enacted.

These are the shark-infested waters we swim in these days. We're either greedy or careless. Either way, kill all the doctors (in the revisionist, postmodern Shakespearean rewrite).

23 comments:

If you can tell me how to eliminate out of hospital infections, I'll tell you how to eliminate in hospital infections. I'm thinking John Travolta and the bubble boy need to make a tour across the US explaining how easy it is to avoid infections.

Anon-Being an advocate for implementing practices that decrease infections is one thing. Pompously declaring that doctors and hospitals need to eliminate all infections within 2 years is quite another. It's so laughable and uninformed, it's almost shocking. Scary that O'Neill is able to spout such nonsense from the NY Times platform...

O'Neil's claim to fame was perfecting the business practice of rolling aluminum from giant ingots into product ordered by Boeing and Renold's Aluminum Foil.

This process is done on a massive scale on the banks of the Mississippi River in Iowa. The only casualties are the River Eco-System and the massive air pollution. There are legends describing the catfish near the warm water outlets of the Alcoawater disposal sewer outlets.

O'Neil was fired from the Bush Administration for being a loose canon. He was not a good fit for a political position, because his only life-experience was either being in charge or rising to a position of being in charge. He hit a brick wall reporting to the President, and was almost literally body-slammed out of office due to his lack of loyalty.

O'Neil commenting on infection rates of "central lines" (which he probably first read about the suspenseful stories in Atul's first book), is as absurdas Dr. Buckeye weighing in on the best alloy and annealing processes to avoid aluminum fatigue in aircraft structures.

As an aside....

An area similar to medical errors is aircraft airworthiness. Their diagnostic procedures haveanalogies to the medical profession. Once you inspect an aircraft component, and certify it "good" (disease free?), that component is good for another N flights of compression/decompression.

This is all good, but the problem is that defects are missed in the certifying inspection. This is what led to several disasters (Aloha flight 243 and UAL 232 ) Both missed key defects.

How is O'Neil going to address human error, that even if decreased to 0.01%, amounts to a significant number when you multiply it by the number of examinations performed every year.

He does not understand that the only way to driveerrors and undesirable outcomes to zero, is to fund a system designed to do so. Can you imagine the specifications?

It would amount to plugging 300 million people into a reliability failure model. To produce zerofailures overall with 300 million components, would require a "per procedure" failure rate well below (1 - 0.9e12)

Ain't gonna happen in any universe we live in.

O'Neil is beyond his scientific reasoning capabilities. He should stick to running aluminum rolling mills.

It gets to be a little unnerving when the media and the public start touting your profession as the source of all the world's problems. Sort of like when the insurance industry enlisted the help of doctors to scream about a "malpractice crisis" and held all lawyers up as boogeymen. Now that tort reform is in place in many places, and your malpractice insurance rates haven't lowered, you can see the real problem was the insurance industry, not lawyers. People will come to realize doctors are not to blame for the health care crisis, too, but not until it is too late.

From Denniger at Market TickerHealth care "reform" is the current hot-button, with the Obama administration now talking about a "public" health-insurance system to "keep the system honest."

Uh huh.

Look folks, you want to know why we have the health cost problems we have? I'll lay it out for you - in a way you can't refute or argue with:

There are no published prices. In no other line of work is it legal to do this. Nowhere. You can't sell someone a hot dog and tell them after they eat it what it just cost them. You can't hire a lawyer and have him tell you "I'll tell you what this will cost when we're done." You can't hire an electrician and have him tell you "I'll make up a bill when I'm done." In every line of work except health care, this is illegal. There are even laws

Bush fired Paul O'Neil because he told the administration they shouldn't run budget deficits. At some point the United States could end up like Argentina and have huge inflation. The United States at some point will have to live with in its means.

You do realize what "blocking generics" mean, don't you? It means instead of selling generic baking soda (sodium bicarbonate) for $0.99 per box, they pull the product off the shelf and sell GNIKAB Ultra at $39.99 per bottle.

Perhaps it only matters if you are on the receiving end of the counter.

Odd that the Governments perception of everything negative that happens in a hospital is:a. Avoidableb. The fault of either the doctor or the staffc. Has nothing to do with the well being of the patient BEFORE they arrived at the hospital

After 30+ years in the business Ihave yet to meet a physician or hospital employee that has started their day by saying' Today I will infect someone"

Odd that the Governments perception of everything negative that happens in a hospital is:a. Avoidableb. The fault of either the doctor or the staffc. Has nothing to do with the well being of the patient BEFORE they arrived at the hospital

After 30+ years in the business Ihave yet to meet a physician or hospital employee that has started their day by saying' Today I will infect someone"

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